论文部分内容阅读
目的了解烧伤后早期肠内营养添加谷氨酰胺(Gln)对患者免疫调理状态的影响。方法将24例烧伤患者随机分为2组,每组12例。标准营养(EN)组:给患者喂食标准肠内营养制剂能全力;免疫营养(EIN)组:喂食能全力+Gln。分别于伤后1、4、7、10d清晨空腹抽血,检测血清总蛋白(TP)、白蛋白(ALB)、前白蛋白(PAB)、转铁蛋白(TF)和免疫球蛋白IgG、IgA、IgM的浓度以及T淋巴细胞亚群CD3~+、CD4~+、CD8~+和CD4~+/CD8~+的比值。结果伤后各时相点2组患者TP、ALB、TF、CD3~+、IgM组间比较,差异均无统计学意义(P>0.05)。伤后4、7、10d,EIN组患者PAB浓度分别为(90±14)、(92±16)、(106±21)mg/L,显著高于EN组(60±15)、(64±13)、(72±17)mg/L (P<0.05)。伤后7、10d,EIN组CD4~+细胞百分比为(55±5)%、(56±5)%,明显高于EN组的(45±5)%、(49±5)%(P<0.05);CD4~+/CD8~+比值为1.92±0.31和2.36±0.36,明显高于EN组的1.53±0.27和1.72±0.42(P<0.05);IgA分别为(2.8±0.6)、(3.1±0.6)g/L,IgG为(12.1±1.3)、(14.2±1.3)g/L,显著高于EN组的IgA[(2.2±0.5)、(2.5±0.5)g/L,P<0.05]和IgG[(9.8±1.2)、(10.4±1.3)g/L,P<0.05]。结论添加Gln的肠内营养制剂可以促进免疫球蛋白IgA、IgG的合成并增加PAB浓度,改善患者营养状况,纠正免疫功能紊乱。
Objective To understand the effect of early enteral nutrition of glutamine (Gln) on immune status of patients after burn injury. Methods Twenty-four patients with burn were randomly divided into two groups (n = 12 in each group). Standard nutrition (EN) group: patients fed standard enteral nutrition can be fully; immune nutrition (EIN) group: full feeding + Gln. Fasting blood samples were collected at 1, 4, 7, and 10 days after injury, respectively. Serum total protein (TP), albumin (ALB), prealbumin (PAB), transferrin (TF) and immunoglobulin IgG , IgM concentration and T lymphocyte subsets CD3 ~ +, CD4 ~ +, CD8 ~ + and CD4 ~ + / CD8 ~ + ratio. Results There was no significant difference in TP, ALB, TF, CD3 ~ + and IgM between the two groups at each time point after injury (P> 0.05). The levels of PAB in EIN group were (90 ± 14), (92 ± 16) and (106 ± 21) mg / L at 4,7 and 10 days after injury, respectively, which were significantly higher than those in EN group 13), (72 ± 17) mg / L (P <0.05). At 7 and 10 days after injury, the percentage of CD4 ~ + cells in EIN group was (55 ± 5)% and (56 ± 5)%, significantly higher than that in EN group (45 ± 5% and 49 ± 5%, P < 0.05). The ratio of CD4 ~ + / CD8 ~ + was 1.92 ± 0.31 and 2.36 ± 0.36, which was significantly higher than that of EN group (1.53 ± 0.27 and 1.72 ± 0.42, P < ± (2.2 ± 0.5) g / L, (P <0.05) ± (2.5 ± 0.5) g / L, respectively ] And IgG [(9.8 ± 1.2), (10.4 ± 1.3) g / L, P <0.05]. Conclusion Enteral nutrition with Gln can promote the synthesis of immunoglobulin IgA and IgG and increase the concentration of PAB, improve the nutritional status of patients and correct the immune dysfunction.